Reperfusion showed stronger association with good clinical outcome than did recanalization.

Thirty-one patients with acute cerebral infarction were treated with the thrombolytic agent urokinase for either a single or a double infusion period, each of ten hours. The effects of urokinase therapy administered at dosage rates of 1,200, 1,500 or 1,700 CTA urokinase units per pound of body weight per hour were followed by serial blood coagulation and other biochemical studies. In the dosage used, urokinase produced a prompt sustained increase, 20-fold to 40-fold, of plasma thrombolytic activity with relatively minor disturbance of the blood coagulation system. Nevertheless, hemorrhagic complications occurred in several patients and distinctly favorable therapeutic effects were not observed.

BACKGROUND AND PURPOSE:Multiple patient-specific clinical and radiologic parameters impact traditional perfusion thresholds used to classify/determine tissue outcome. We sought to determine whether modified baseline perfusion thresholds calculated by integrating baseline perfusion and clinical factors better predict tissue fate and clinical outcome.

SUMMARY Plasma fibrinogen chromatography is a method for quantification of high molecular weight fibrinogen complexes (HMWFC), native fibrinogen and other fibrinogen derivatives in plasma. Enhanced formation of fibrin, intravascular coagulation, thrombus formation, etc., are reflected by elevation of plasma HMWFC, and the method distinguishes between subjects with normal and pathological rates of fibrin formation.Serial standard blood coagulation assays, including plasma fibrinogen chromatography, and neurological studies were performed on 220 patients admitted to a stroke unit.Findings from patients with cerebral infarction were compared against those of three control groups: (1) normals, (2) a stroke control group and (3) a stroke risk factor group. Plasma HMWFC findings were significantly (p < 0.001) higher in the stroke risk factor group than in the normals. Plasma HMWFC values were significantly higher (p < 0.001) in the cerebral infarction patients than in any of the control groups, and plasma fibrinogen, plasminogen, alpha,-antitrypsin and alpha^macroglobulin also were significantly higher (p < 0.001) in the patients. The greater the degree of initial neurological deficit, the greater were plasma HMWFC values (p < 0.001), and high HMWFC values were associated with poor clinical outcome.Plasma HMWFC values were significantly higher (p < 0.001) in patients with intracerebral hemorrhage, subarachnoid hemorrhage and cerebral embolism.These findings document the fact that a high proportion of stroke patients have coagulopathy, characterized by pathological enhancement of fibrin formation.

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